Death, Dying and DHA


The November Blog from Duncan Hynd…A Radiographers life in Radiotherapy

Prima Facie is a Latin expression meaning on its first encounter or at first sight.

The literal translation would be “at first face” or “at first appearance” from the feminine forms of primus and facies, both in the ablative case.

In modern, colloquial and conversational English, a common translation would be “on the face of it”. The term prima facie is used in modern legal English including both civil law and criminal law to signify that upon initial examination, sufficient corroborating evidence appears to exist to support a case.

The Prima Facie system.

DHA created a novel product based on a hand held 3D scanning system and 3D surface measurement and analysis module and named it rather well in my opinion…Prima Facie!

Originally designed and written for dimension critical surgical evaluation and prosthetics production at UCL, the measurement and analysis module had a wide ranging non-medical and medical applications where accurate dimensional analysis and comparison of 3D surfaces is required.

Pic: Fast Scan 3D scanner

 

The creator of this leading-edge evaluation software was Prof Alf Linney, a reader in Medical Graphics at UCL and also a DHA director in those days. I recall when meeting Alf for the first time just how clever him and his team were and one thing that has stayed in my mind today was that you could measure the distance between the inner canthus of both eyes to see if someone had potential criminal tendencies. Every day I am out in the city I am always drawn to people’s eyes!

In Radiotherapy we were also trained to use surface anatomy to guide our treatment beams such as a line drawn between the superior orbital margin or SOM and external auditory meatus or EAM that defined the inferior border of the brain for irradiating the whole brain when treating it for distant metastases but that did not ascertain an individual’s potential for crime!

One of the areas of interest in using Prima Facie was the forensic analysis of scenes of crime and murder victims that tied the product in nicely to its innovative name when referenced to criminal evidence!

We will come back to that later in this blog.

How did the software work?

After import, the scanned object was viewed within the coordinate system defined by the viewing screen. If required a user defined coordinate system could be constructed with reference to three landmarks on the object. These could be naturally occurring features or physical marker objects placed on the object and acquired during normal scanning of the object.

Pic: Facial analysis software

 

Three electronic markers placed at landmark points on the surface were used to establish the user defined coordinate system within which all measurements and marker positions were referenced.

This allowed for facial assessments to be made and recognised using automated processes including the potential to combine the images with reconstructed CT data.

True distance measurements across a 3D surface using electronic markers applied to define landmark points were also possible.

Mirror-imaging for prosthesis simulation and model production was provided with software interfaces in STL format for rapid-prototyping or what is now known as 3D printing.

Pic: Our life size model of Mozart scanned into the analysis software!

 

Radiotherapy applications for Prima Facie

We also created an innovative software package for radiotherapy that allowed you to scan a patient and create a rendered image that could be broken down into transverse, sagittal and coronal “contours” that were input into a treatment planning system for simple 2D planning purposes. This was prior to the use of CT scans and CT Simulators and saved on the use of a digitiser and lead wire to obtain a planning outline of the breast for instance.

Pic: A 3D image showing the selected contours for treatment planning

 

The system also allowed you to send the 3D image of the head and neck to a CNC milling machine to create an immobilisation mask for the patient from a model without the need to take a hot, messy and claustrophobic plaster impression. We called this the “virtual mask maker” that was essentially made redundant when perforated thermoplastics were implemented into the clinical routine.

All that remains…a Life in Death

 

I have just finished this book and would highly recommend it to anyone working in radiotherapy, cancer care and the medical sector.

The quote in the introduction by Norman Cousins, a political journalist says that “Death is not the greatest loss in life, the greatest loss is what dies inside us while we live” which is very prescient when as with me you are approaching retirement age following a career spent in its entirety in the radiotherapy and cancer care field.

Death is referred to as a female, “She” is personalised as sinister and a harbinger of pain and unhappiness… she has ominous names such as the Grim Reaper and we have come to dread her presence as if she were somehow infectious… we learn at a young age a language to blunt her sharp edges and dull the pain and talk of “losing” someone, whisper of their “passing” and commiserate with others when someone has “gone”. Sue Black knows where her father is and she didn’t “lose” him, he is in a box in a cemetery in Inverness!

I know that when my father died aged 69 from Prostate cancer that he was also in a box but in Dorset and so am a great proponent and supporter of the charity “Dying Matters”. Dying Matters is a coalition of individual and organisational members across England and Wales, which aims to help people talk more openly about dying, death and bereavement, and to make plans for the end of life.

Read more about them here: https://www.dyingmatters.org/

Pic: It was the salmon mousse! (but I didn’t have any…The Grim Reaper in Monty Python’s The Meaning of Life)

 

In her book, Sue Black confronts death every day. As Professor of Anatomy and Forensic Anthropology, she focuses on mortal remains in her lab, at burial sites, at scenes of violence, murder and criminal dismemberment, and when investigating mass fatalities due to war, accident or natural disaster. In All that Remains she reveals the many faces of death she has come to know, using key cases to explore how forensic science has developed, and what her work has taught her.

Do we expect a book about death to be sad? Macabre? Sue’s book is neither. There is tragedy, but there is also humour in stories as gripping as the best crime novel.

Our own death will remain a great unknown. But as an expert witness from the final frontier, Sue Black is the wisest, most reassuring, most compelling of guides.
Go buy the book now, you will not be disappointed, I promise!

The war in Kosovo

The Kosovo War was an armed conflict in Kosovo that started in late February 1998 and lasted until 11 June 1999. It was fought by the forces of the Federal Republic of Yugoslavia (i.e. Serbia and Montenegro), which controlled Kosovo before the war, and the Kosovo Albanian rebel group known as the Kosovo Liberation Army (KLA), with air support from the North Atlantic Treaty Organisation (NATO) from 24 March 1999, and ground support from the Albanian army.

Read more: https://en.wikipedia.org/wiki/Kosovo_War

After the war, a list was compiled which documented that over 13,500 people were killed or went missing during the two-year conflict. The Yugoslav and Serb forces caused the displacement of between 1.2 million to 1.45 million Kosovo Albanians.

There was widespread evidence and reports of war crimes, genocide, ethnic cleansing and the mass killing of innocent civilians including women and children.

Pic: The picturesque town of Prizren in Kosovo

 

In Chapter 10 of her book, entitled “Kosovo” Sue Black takes a phone call from Peter Vanezis in June 1999 at the time a Home Office Pathologist at Glasgow University where she was a forensic anthropologist who asked her what she was doing that weekend, when she asked why he said ”You are coming out to Kosovo”. She was to be part of a British forensic team gathering evidence to assist in charging the Serbian Army with war crimes. I’ll leave you to read the book but she has to examine and identify lots of bodies in pretty horrendous circumstances.

Peter Vanezis has been a forensic pathologist since 1974 with an interest in human identification, genocide investigation, and human rights issues. He has worked in London and Glasgow assisting in homicide investigations and was a senior civilian consultant in forensic medicine to the armed forces.

Importantly to this blog, Peter was one of the first users of our Prima Facie system for forensic medicine applications with its ability to scan human remains in situ and so I hope that this DHA product played some part in gaining justice for those victims murdered in this war, their families and subsequent victims of crime. You don’t believe that when you create a business and a product whether it be for radiotherapy or forensic use that it might make such a fundamental difference to people’s lives!

Dying of Cancer is the “best death”

While on the subject of Death, I wanted to end this blog on a news item from late 2014 entitled…Dying of cancer is the “best death” and we should “stop wasting billions trying to cure”.

Dr Richard Smith, a former editor of the British Medical Journal, said that cancer allowed people to say goodbye and prepare for death and was therefore preferable to sudden death, death from organ failure or “the long, slow death from dementia”.

Referring to the writings of surrealist Luis Buñuel, Dr Smith said that cancer was the closest thing to the filmmaker’s professed wish for “a slower death”.

“You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favourite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion,” Dr Smith wrote in a blog published for the BMJ, a journal he edited until 2004.

“This is, I recognise, a romantic view of dying, but it is achievable with love, morphine, and whisky. But stay away from overambitious oncologists, and let’s stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death,” he wrote.

In his blog, he argues that a quick, sudden death – despite being most people’s choice – can be hard on bereaved relatives and friends, particularly where there are unresolved issues in a relationship, while organ failure can leave people “far too much in hospital and in the hands of doctors,” he wrote. A death following dementia, he writes “may be the most awful as you are slowly erased”.

Read more: www.independent.co.uk/life-style/health-and-families/health-news/cancer-is-best-death-so-dont-try-to-cure-it-says-doctor-9952361.html

Cancer ‘the best way to die’? You couldn’t be more wrong if you tried

There was an immediate response by a cancer patient published by CRUK that concludes:

Richard, you really can’t believe in those words you wrote. According to the latest figures, 2.5 million people in the UK are living with and beyond a cancer diagnosis. It is absolutely vital that we continue to research the prevention and treatment of the disease.

In conclusion, the one thing we would probably agree on, if you were brave enough to meet me, is that as a society we should get our s**t together on assisted dying.

I still don’t get why we are able to do it for animals, but refuse it for humans.

But as I face the inevitable outcome of my terminal diagnosis, the one thing I REALLY want, above all else, is the opportunity to say “I’ve had enough, it’s time to put me to sleep”

Read more: https://scienceblog.cancerresearchuk.org/2015/01/19/cancer-the-best-way-to-die-you-couldnt-be-more-wrong-if-you-tried/

Whatever your opinion on Death especially with reference to the radically opposing views above and whether as a radiotherapy professional, patient, relative, as an interested human being or just based on religious beliefs, as Sue Black states…”we will not be laughing when we reach the top of her list and she does finally call out our name.” In the end and in the words of JM Barrie (Peter Pan) “To die will be an awfully big adventure”.

 

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